Objective This study aimed to compare the efficacy and safety of romosozumab, a bone anabolic agent, versus vertebroplasty, a conventional surgical intervention, in treating osteoporotic vertebral compression fractures (OVCFs).
Methods A retrospective analysis included 86 thoracic/lumbar compression fracture patients from 2014 to 2022 at a medical center. Forty-two patients received romosozumab (monthly injections for 1 year) followed by 1 year of denosumab, while 44 underwent vertebroplasty followed by denosumab injections biannually for 2 years. Outcomes were assessed using the Numerical Rating Scale (NRS) for pain, bone mineral density (BMD), vertebral compression ratio, and Cobb angle over 12 months.
Results At 12 months, the romosozumab group showed a greater reduction in NRS scores (4.90 ± 1.01 vs. 4.27 ± 1.34, p = 0.015) and a higher increase in lumbar BMD (0.8 ± 0.5 vs. 0.5 ± 0.3, p = 0.000) compared to the vertebroplasty group. There were no significant differences in changes in hip total BMD and femur neck BMD (p = 0.190, p = 0.167, respectively). Radiographic assessments showed no significant differences in vertebral compression ratio (14.7% vs. 14.8%; p = 0.960) or Cobb angle (4.2° vs. 4.9°; p = 0.302). The incidence of major osteoporotic fractures was lower in the romosozumab group (7.1% vs. 25.0%, p = 0.051), with similar rates of cardiovascular events in both groups (4.8% vs. 9.1%, p = 0.716).
Conclusion Romosozumab has demonstrated superior pain reduction and lumbar BMD improvement compared to vertebroplasty at 12 months, with no significant differences in radiographic outcomes or adverse events, suggesting it as an alternative to vertebroplasty for OVCF.
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Objective Romosozumab is increasingly employed to manage osteoporosis. However, no studies have analyzed its effects on recent osteoporotic vertebral compression fractures (OVCFs). Therefore, this study aimed to evaluate the efficacy of romosozumab compared with teriparatide in managing OVCFs.
Methods The electronic medical records of postmenopausal patients with recent OVCFs who were administered romosozumab or teriparatide for one year from March 2018 to August 2022 were retrospectively reviewed. We compared the 2 groups for demographics, radiological outcomes (compression ratio, Cobb angle, and bone mineral density [BMD]), and clinical outcomes (Numerical Rating Scale [NRS] for back pain).
Results Fifty-five patients with OVCFs, 32 patients treated with romosozumab and 23 with teriparatide, were included in this study. The change of BMD (g/cm2) values was significantly higher (p = 0.016) in the romosozumab (0.04 ± 0.06) than in the teriparatide group (0.00 ± 0.08) in the femur total. Furthermore, in subgroup analysis, the change of BMD (g/cm2) values in the lumbar spine was significantly higher (p = 0.016) in the romosozumab (0.12 ± 0.06) than in the teriparatide group (0.07 ± 0.06) in the lumbar spine. The decrease in NRS was significantly higher (p = 0.013) in the romosozumab (6.6 ± 2.0) than in the teriparatide group (5.5 ± 2.1). However, there was no significant difference in radiologic outcomes between the 2 groups.
Conclusion Our findings suggest that romosozumab may be more effective than teriparatide in treating OVCFs in postmenopausal females, particularly in improving BMD and reducing back pain as measured by NRS.
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Objective We aimed to comprehensively compare surgical methods for osteoporotic vertebral compression fracture (OVCF) using systematic review and network meta-analysis to understand their effectiveness and outcomes, as current research provides limited overviews.
Methods We followed PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines, preregistering our protocol with PROSPERO. We analyzed Englishpublished randomized controlled trials (RCTs) on adults with OVCFs that evaluated pain intensity or functionality using tools like visual analogue scale (VAS) or Oswestry Disability Index (ODI). Exclusions included non-RCTs, malignancy-related fractures, and certain interventions. Using the RoB 2 tool, we assessed bias and visualized results with Robvis. Our primary outcome was pain intensity, with secondary outcomes including disability, new fractures, and cement leakage. Results were synthesized using Stata/MP.
Results Thirty-four RCTs from 10 countries, totaling 4,384 patients, were analyzed. Shortterm VAS indicated kyphoplasty with facet joint injection (KIJ) as the top treatment at 87.7%, while unipedicular kyphoplasty (UKP) led to long-term at 74.9%. Short-term ODI favored vertebroplasty with facet joint injection (VIJ) at 98.4%, with kyphoplasty (KP) leading longterm at 66.0%. All surgical techniques were superior to conservative treatment. Vertebral augmentation devices reported the fewest new fractures and curved vertebroplasty had the least cement leakage. SUCRA (surface under the cumulative ranking) analyses suggested UKP and VIJ as top choices for postoperative pain relief, with VIJ excelling in postoperative disability improvement.
Conclusion Our analysis evaluates 12 OVCF interventions, underscoring KIJ for short-term pain relief and VIJ and UKP for long-term efficacy. Notably, VIJ stands out in disability outcomes, emphasizing the need for comprehensive OVCF management.
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Methods We retrospectively investigated 487 consecutive patients diagnosed with vertebral body fractures between January 2018 and December 2022. Only patients with their fresh vertebral fracture episode during the study period were included. Patients were classified into 3 groups: conservative treatment, balloon kyphoplasty (BKP), and open surgery. OF classification and OF scores were assessed for each patient.
Results A total of 237 patients with OVCF were included. There were 127, 81, and 29 patients in the conservative, BKP, and open surgery groups, respectively. The OF score was significantly higher in the BKP and open surgery groups than in the conservative group (p < 0.001). Multivariate logistic regression analysis showed that antiosteoporotic drug use, OF classification, progressive deformity, neurological symptoms and mobilization were independent risk factors for operative treatment (all p < 0.001). Receiver operating characteristic analysis showed that the cutoff OF score for operative indication was 5.5, with a sensitivity of 91.9%, specificity of 56.5%, and area under the curve of 0.820 (95% confidence interval, 0.769–0.871).
Conclusion The OF score identified patients who required operative treatment with a high degree of accuracy. This is especially important for ruling out patients who definitely require operative treatment.
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Objective To compare unilateral extrapedicular vertebroplasty (UEV) and bilateral transpedicular vertebroplasty (BTV) by quantitatively calculating the structural changes of fractured vertebral body after percutaneous vertebroplasty (PVP) using 3-dimensional voxel-based morphometry (VBM).
Methods We calculated bone cement volume (BCV); vertebral body volume (VBV); leaked intradiscal BCV; and spatial, symmetric, and even bone cement distribution (BCD) in and out of 222 vertebral bodies treated with 2 different PVPs using VBM and evaluated the incidence of subsequent vertebral compression fracture (SVCF). Statistical analyses were conducted to compare values between the 2 different PVPs.
Results Relative BCV, which is a potential risk factor for SVCF, was higher in the BTV group based on the data using VBM (0.22±0.03 vs. 0.29±0.03; p<0.001, t-test); however, the SVCF incidence between the 2 surgeries was not significantly different (UEV, 24.7%; BTV, 31%; p=0.046, chi-square test). Spatial, even, and symmetric BCD along the 3 axes was not significantly different between UEV and BTV using VBM (x, y, z-axis, p=0.893, p= 0.590, p=0.908 respectively, chi-square test).
Conclusion Contrary to intuitive concerns, UEV can inject a sufficient and more optimal BCV than BTV. Additionally, it can inject bone cement spatially, symmetrically, and evenly well-distributed without an increased rate of intradiscal leakage and SVCF compared with BTV based on VBM. Therefore, UEV could be a superior alternative surgical method with similar clinical effectiveness and safety, considering the above results and the consensus that UEV is less invasive.
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Objective We retrospectively analyzed patients with osteoporotic vertebral compression fracture (OVCF) undergoing vertebral augmentation to compare the Cobb angle changes in the supine and standing positions and the clinical outcomes.
Methods We retrospectively extracted the data of OVCF patients who underwent vertebral augmentation. Back pain was assessed using a visual analogue scale (VAS). Supine and standing radiographs were assessed before treatment to determine the Cobb angle and compression ratio. Receiver operating characteristic curve analysis was performed to determine the optimal cutoff to predict favorable outcomes after vertebral augmentation.
Results A total of 249 patients were included. We observed a statistically significant increase in the VAS score change with increasing Cobb angle and compression ratio (p < 0.001), and multivariate logistic regression analysis showed that a difference in the Cobb angle (odds ratio [OR], 1.27) and compression ratio (OR, 1.12) were the independent risk factors for predicting short-term favorable outcomes after vertebral augmentation. In addition, we found that the difference in the Cobb angle (OR, 1.05) was the only factor for predicting midterm favorable outcomes after vertebral augmentation. The optimal cutoff value of the difference in the Cobb angle for predicting midterm favorable outcomes was 35.526°.
Conclusion We found that the midterm clinical outcome after vertebral augmentation was better when there was a difference of approximately 35% or more in the Cobb angle between the standing and supine positions. Surgeons should pay attention to the difference in the Cobb angle depending on the posture when deciding to perform vertebral augmentation in patients with OVCFs.
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OBJECTIVE Recently, the definition of occult osteoporotic vertebral fracture has been established, and its clinical significance has come to our interest. We report the effect of early percutaneous vertebroplasty in occult osteoporotic vertebral fracture. METHODS From January 2006 to January 2008, we performed percutaneous vertebroplasty for 50 levels in 47 patients. 21 levels (21 patients) of them were classified into occult osteoporotic vertebral fracture group, 29 levels (26 patients) were categorized into control group (not occult osteoporotic vertebral fracture) by the Pham T..s criteria.
We obtained VAS score and measured the compression ratio at first hospital day and 1 day, 1 month, 3 months after procedure. RESULTS There are noticeable improvements in VAS score. The mean VAS score at admission was 6.44 in occult group and 6.15 in control group, which changed 2.23 in occult group and 2.68 in control group after procedure. The compression rate was 1.008, 1.018, 1.016 in occult group and 0.862, 0.891, 0.881 in control group at admission and 1 month, 3 months after procedure. The conservative effect for vertebral height was higher than control group (p=0.011). CONCLUSION Percutaneous vertebroplasty in occult osteoporotic compression fracture provided significant pain relief and conservative effect for vertebral height. It is probable that it can lower the rate of secondary adjacent vertebral compression fracture.
The authors report 2 patients with benign vertebral compression fracture with intravertebral vacuum. Both patients suffered from back pain after minor back trauma and were treated by kyphoplasty. The spine images of one case shows intra-and inter-vertebral vacuum dots since 1weeks after trauma. The other's shows only intravertebral vacuum dots immediately after trauma and then intravertebral vacuum cleft(Kummell's disease) 5 weeks after trauma. The authors speculate that Kummell's disease(delayed posttraumatic vertebral collapse with intravertebral vacuum cleft) was evolved from untreated or unrecognized vertebral compression fracture. Kummell's disease is not a independent disease entity.
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